INTRODUCTION
This thesis aimed to assess and explain variation in perioperative practices for elective medium-tohigh-risk abdominal surgery. Although perioperative mortality rates decreased substantially over years for abdominal surgery, perioperative complication rates are still a significant burden for patients and society. Can we distill a best practice strategy aimed at complication reduction? What are the underlying physiological principles and how can these findings be translated to daily clinical practice? What is the role of dynamic indices in predicting fluid responsiveness? And what is the effect of fluid loading on glycocalyx integrity? Will forced optimization of hemodynamics in abdominal surgery result in improvement of microcirculatory perfusion at all? This thesis therefore outlines the role of standardization and hemodynamic optimization using goal directed therapy (GDT) for detection and treatment of hemodynamic imbalances.
